Cushings?

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smilelari

smilelari

Member Since 2016
I am a terrible board member and haven't been on in probably a month or two. Sorry about that

Turner was doing pretty well, until today. We switched to SLGS, and we've been going very slow due to some summer travel and activities preventing us from testing as often as we'd like. He's seemed relatively happy and healthy. Still ravenous, but drinking and peeing normally and grooming himself.

But now he's at the emergency vet. This evening, clumps of hair started falling out. As well as some skin flaked off and there was a flap of skin torn. Have no idea really what happened. One minute everything was normal, the next my husband was asking WTF happened to the cat. Ran him to our regular vet. They were close to close and really didn't have the personnel to help us and sent him along to the ER. Still deciding options there, but it looks like they're leaning towards putting him under to suture the open wound and to do some blood work and then going back to our regular vet tomorrow

We asked about testing for cushings. He's had unexplained skin lesions before. This is starting to feel like obvious cushings to me. But they kind of scoffed at testing for cushings saying that it's incredibly rare, especially for males.

Anyone have experience with this? Should I keep pushing to test for cushings?

TIA
 
@Vyktors Mum - Serryn's mum's cat Purrdy also has Cushings. Both Purrdy and Mary Ann's Tuxie are boys. We had another Cushings kitty earlier this year, also a boy. Here's a recent post about Purrdy with some info about Cushings. I would push to get the tests done. Sending vines for Turner.
 
smilelari said:
Anyone have experience with this? Should I keep pushing to test for cushings?
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So sorry to hear the problems you are having with Turner. The skin tearing is a definite warning sign of potential Cushing's. Although vets feel that Cushing's is very rare my opinion is that it is under-reported and not often tested for. Many years ago Acro was considered rare and now it has been found to be much more common than previously thought. In just under 2 years since I have been on this forum I have seen 4 definitely diagnosed kitties, another one on a different forum, plus my own and another strongly suspected. The only research done, years ago, states that there were only 100 known cases, so definitely it is more common that previously believed. Cushing's is quite common in dogs, so most of the treatment protocols are based on canines.

Cushing's can be due to a tumour on the pituitary gland (PDH) or a tumour on the adrenal gland (ADH) What is happening in a nutshell is that the tumours are causing the body to constantly be producing excess natural cortisol, which basically is a steroid hormone. The PDH type is more common with dogs and since ther is not much research on this disease with cats, the same line of thought applies with them as well.

Kitties with Cushing's are very hard to regulate because of the spurts of cortisol being produced. Often there is symmetrical hair loss and poor regrowth. My Tuxie was shaved for his first ultrasound in January 2015 and the hair still has not grown back. Cushing's kitties can experience either weight loss or weight gain and very often have a pot bellied appearance due to organomegaly...inflammation of the adrenals, liver and pancreas, since these organs are constantly being stressed.

The simplest, least invasive (and cheapest) diagnostic is the UCCR test...(urine cortisol creatinine ratio) You would take a sample of urine AT HOME in order not to have vet stress factor in. Your vet would send it to an outside lab such as IDEXX and they would run the test. This measures the amount of cortisol being excreted in the urine..in Cushing's kitties there is a much higher amount than in normal kitties. If the test comes back positive, then that is the diagnosis. If it comes back borderline, and ultrasound can be done to see the condition of the liver/pancreas/adrenals. There are other diagnostic tests that can be done and f you need more information I can go through my notes.

Trilostane (vetoryl) has been used to help slow down the effects of Cushing's. It is used extensively with dogs, but does have risks, Because the drug curtails the effects of cortisol, which is naturally produced in a normal animal, it can lead to Addison's disease, which is low cortisol. This can create an emergency situation..(comparable to a kitty being hypoglycemic as opposed to being hyperglycemic), which can be life-threatening. A kitty on trilostane would have to have biweekly ACTH stimulation tests done to adjust the levels of trilostane being given. There is also the surgical approach, but the risks are quite high, Radiation is another option.

Once the disease progresses to massive skin tears, it becomes harder to deal with, since it is almost impossible to repair the tears.

I would suggest pushing your vet for the UCCR test, which is very simple to do and see what results you get from that.

Prayer and :bighug::bighug:
 
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Thanks for the helpful response. We definitely have hair that hasn't regrown from where the iv was when he had his dental and where they shaved him to laser treat the previous lesions
Our vet said that they see that with diabetes sometimes. Poor hair regrowth.

He is also quite pot bellied! But he's pretty fat too.

Off to get him the morning. Did ok with surgery. They found other lesions starting to form when they shaved him though
 
My vet had also said poor hair regrowth is not unusual with diabetes. However after over 1 1/2 years since the U/S shave, there should be some regrowth. The IV sites and shaved areas from blood draws have regrown somewhat. My vet pooh-hood Cushing's when I decided to start testing. The U/S vet (different clinic) said the organomegaly was indicative of Cushing's. He had done diagnostic U/Ss for a couple of kitties who were positively diagnosed as Cushing's with further testing. His subjective diagnosis after the first U/S was PDH Cushing's. I did two other tests after that came back as early Cushing's and my vet no longer questions why I insisted on the testing. Most vets will deal with a number of Cushing's dogs but rarely if ever with a Cushing's kitty since most people do not have their kitty tested.

Here is some basic information on the UCCR test. As I previously said it is the easiest and least intrusive test. A negative is a negative. A positive would require additional testing for verification and determining whether it is PDH or ADH.

http://www.vcahospitals.com/main/pet-health-information/article/animal-health/urine-cortisol/440

Good luck with Turner :bighug:


ETA Tuxie's potbelly makes him look like he is pregnant...which of course is impossible :) It is a different look than a fatter kitty.
 
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Mary Ann reminded me of a couple of articles/presentations I'd seen on Cushings. The first is a presentation by Dr. David Bruyette of the VCA West LA Vet hosplital. It's a long presentation on insulin resistance (incuding dogs), but starting page 20 is some info on Cushings. It claims Cushings (hyperadrenocortisism) is responsible for up to 17% of feline diabetes. (acromegaly is 25%). Page 29 is the section on feline cushings.

The second one is an article from the folks at the Royal Veterinary College, see starting the bottom of page 330 for the section on Cushings, including pictures of kitties with the condition and description of tests. Note this particular article says there have been 100 cases in veterinary literature, but even Neko's vet has seen a Cushings kitty:
Hypersomatotropism, Acromegaly, and Hyperadrenocorticism and FelineDiabetes Mellitus
by Stijn J.M. Niessen, David B. Church, Yaiza Forcada, 2013
http://www.academia.edu/9267158/Hyp...radrenocorticism_and_Feline_Diabetes_Mellitus

Keep us posted with how Turner is doing. Sending vines. :bighug:
 
Thanks for posting these articles Wendy. I read the Niessen article about a year ago but couldn't find the link in my files. This article is excellent and the illustrations of the pot belly show much better than trying to describe it.
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:bighug::bighug::bighug: Sending many vines for Turner. We haven't bothered testing because it's pretty blinking obvious and we won't be going down the surgery or trilostane paths. We had one kitty here Zoey that went with the trilostane, started 5.12.15, which resulted in extreme hypoglycaemia, her spreadsheet is linked below.

For us it is all about keeping Purrdy in the best shape possible and getting ready to say goodbye when it all starts going too pear shaped. I'm sorry to say it but it is best to be prepared. I've seen two beans fight to the bitter end with Cushings and it isn't pretty. So having the benefit of their experience means that we won't be doing that.

In the meantime as you probably read in Purrdy's condo - milk thistle and water soluble Vit e will help support the liver and kidneys.

ETA - Purrdy has been going on for a couple of years now and is still a happy kitty


https://docs.google.com/spreadsheets/d/1ZSx88fvA4ku4mzZA4JZpfAtSs-lEQV9wPqKoaWVN4t0/pubhtml#
 
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I will also add to this that my Tuxie was diagnosed over 1 1/2 years ago with early Cushing's and overall he is doing well (anti-jinx). He is almost 16 and still has a decent QOL (quality of life).
 
Tuxedo Mom said:
I will also add to this that my Tuxie was diagnosed over 1 1/2 years ago with early Cushing's and overall he is doing well (anti-jinx). He is almost 16 and still has a decent QOL (quality of life).
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Hey TuxedoMom

It look like I have a Cushing's kitty, too. My boy is 9 now and has shown signs of Cushing's for almost 7 years. No vets thought to look until my current vet did an abdominal x-ray and noticed calcifications on his adrenals. Do you have any experience with the dex suppression test? My vet wants to go straight there and by-pass the urine test. What did you end up putting Tuxie on med wise? My vet is recommending Trilosane once we get baseline numbers (she's pretty much 100% he has it).

Thanks!!!!
Caroline and Vonnegut
 
Vyktors Mum said:
:bighug::bighug::bighug: Sending many vines for Turner. We haven't bothered testing because it's pretty blinking obvious and we won't be going down the surgery or trilostane paths. We had one kitty here Zoey that went with the trilostane, started 5.12.15, which resulted in extreme hypoglycaemia, her spreadsheet is linked below.

For us it is all about keeping Purrdy in the best shape possible and getting ready to say goodbye when it all starts going too pear shaped. I'm sorry to say it but it is best to be prepared. I've seen two beans fight to the bitter end with Cushings and it isn't pretty. So having the benefit of their experience means that we won't be doing that.

In the meantime as you probably read in Purrdy's condo - milk thistle and water soluble Vit e will help support the liver and kidneys.

ETA - Purrdy has been going on for a couple of years now and is still a happy kitty


https://docs.google.com/spreadsheets/d/1ZSx88fvA4ku4mzZA4JZpfAtSs-lEQV9wPqKoaWVN4t0/pubhtml#
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Hi Vyktors Mum,

Is it typical for Trilostane to drop BG levels so low? Does it eventually level out if you decrease/stop insulin? What should I be looking for to know if my kitty boy is starting to go down hill? I've dealt with Cushing's in dogs and horses but never cats

Thanks!!!
Caroline and Vonnegut
 
Caroline17 said:
Hey TuxedoMom

It look like I have a Cushing's kitty, too. My boy is 9 now and has shown signs of Cushing's for almost 7 years. No vets thought to look until my current vet did an abdominal x-ray and noticed calcifications on his adrenals. Do you have any experience with the dex suppression test? My vet wants to go straight there and by-pass the urine test. What did you end up putting Tuxie on med wise? My vet is recommending Trilosane once we get baseline numbers (she's pretty much 100% he has it).

Thanks!!!!
Caroline and Vonnegut
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When I had Tuxie tested I did the UCCR urine test first, then the HDDS test, then the LDDS test. I also had U/S done about 3 months in and then again a year later...too many symptoms of Cushing's for my likings, even though the vet did not think that could be the problem. It showed both adrenals enlarged, liver and pancreas enlarged, which is symptomatic of the PDH (pituitary tumour) type of Cushing's, rather than the ADH adrenal tumour type. I had most of his tests done very early after the diabetes diagnosis, so a number of them ended up being borderline/low positive. I am sure if I had done more follow-up testing it would have indicated a strong positive. Tuxie passed away just over 2 weeks ago. Signs were pointing to a potential cancer and he was losing weight rapidly and withering away and his QOL was gone, so I helped him cross on May 19.

Tuxie always had the "pot belly" look, never lost weight (until the last month or so) and had no hair regrowth even after over 2 years since the first U/S. He had overall hair thinning all along and his skin was much thinner than normal, although he never reached the skin tearing stage. He was incredibly hard to regulate, especially in the beginning. The highest dose I had him on was 6.5 units of Levemir. He would also do wild swings in glucose levels sometimes going from a PS of 551 to 25 at +7 in the same cycle. I never did try the trilostane, although some people have had good results..at least as far as the diabetic part went. When you are using trilostane you need to have regular ACTH suppression tests done to make sure the dose is correct. Too high a dose of trilostane can cause Addison's ( low cortisol), which is much more life threatening than Cushing's. My belief is that Cushing's in kitties is far more prevalent than the little research that has been done. I really believe that it is under-diagnosed or the kitties end up with other issues and are PTS without it being diagnosed.

I am not really active on here right now, since Tuxie passed...just needed a break away, but if you need more information I would be happy to help.

These are Tuxie's spreadsheets for the last 2 years:

https://docs.google.com/spreadsheets/d/1AnFagJ-xrpNsKlDcUji0m25r9oWHqybV8k-lpe7UX0Q/edit#gid=0

https://docs.google.com/spreadsheets/d/1381KzJkNHfHt7zKjPxnGd170rJ2WkWUGE1th3CY3Fx8/edit#gid=5

:bighug::bighug::bighug::bighug:
 
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@Tuxedo Mom I am so very sorry to hear about Tuxie. Our little fur children come to us, bring us so much joy, and are gone far too soon.

Thank you for all the wonderful information. I'm hoping we can get Vonner sorted out.
 
Caroline17 said:
@Tuxedo Mom I am so very sorry to hear about Tuxie. Our little fur children come to us, bring us so much joy, and are gone far too soon.

Thank you for all the wonderful information. I'm hoping we can get Vonner sorted out.
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Thank you.

If your kitty is diagnosed with Cushing's it is important to know whether it is the PDH or ADH. Trilostane is not useful for the ADH Cushing's. I would suggest having an ultrasound done by a board certified radiologist. It is a much better tool for helping with the diagnosis of Cushing's than an x-ray. PDH Cushing's will usually show enlargement in the liver, pancreas and BOTH adrenals, sometimes with uneven margins, but no lumps or tumours showing. ADH Cushing's (caused by a tumour on the adrenal gland) will usually only show enlargement in one adrenal gland and there is usually some sign of a tumour. So it is omportant to know not only if it is Cushing's but what type of Cushing's.
 
Tuxedo Mom said:
Thank you.

If your kitty is diagnosed with Cushing's it is important to know whether it is the PDH or ADH. Trilostane is not useful for the ADH Cushing's. I would suggest having an ultrasound done by a board certified radiologist. It is a much better tool for helping with the diagnosis of Cushing's than an x-ray. PDH Cushing's will usually show enlargement in the liver, pancreas and BOTH adrenals, sometimes with uneven margins, but no lumps or tumours showing. ADH Cushing's (caused by a tumour on the adrenal gland) will usually only show enlargement in one adrenal gland and there is usually some sign of a tumour. So it is omportant to know not only if it is Cushing's but what type of Cushing's.
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I'm definitely looking into U/S. I suspect that it is PDH Cushing's just based on his shape. We have a really great 24/7 emergency and specialist vet here that has a vet who specializes in U/S. I'm in the works of setting up an appointment with them in addition to the dex suppression test.
 
Just got the test results back. He's definitively Cushing's and it's PDH.

I have been looking into Trilostane, which I thought was going to be $30ish a month. No, it's more like $90. I'm reaching out to some of my veterinary contacts, but I am a little at a loss. He already costs me over $100 a month just for him. Adding all the extra is really going to make things super tight if we can even manage to add that expense with the additional blood tests. I'm just feeling kinda lost and overwhelmed. I don't like having to weigh the health of one pet against the others. I don't like having to possible decline treatment because I can't afford it. Guess I should go do more research.
 
I am so sorry. Yum's sister passed on the operating table, very possibly as an undiagnosed diabetic with Cushings. At least you know what your are dealing with. Vonn is so cute. He reminds me of Yum's sister, another brown tabby. Good luck.
 
Caroline17 said:
I have been looking into Trilostane, which I thought was going to be $30ish a month. No, it's more like $90. I'm reaching out to some of my veterinary contacts, but I am a little at a loss.
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I wonder if you can get the Trilostane from Marks Marine Pharmacy where a lot of us get insulin for a lot less than it costs here in the states.
 
I researched like a fiend last night. I am not ready to give up because Vonn is still happy, engaged, and his normal jerk face/goofy self. I'm glad I did.

My vet is working with me and we've come up with a testing protocol that is more affordable. ACHT tests run ~300 per test. The recommended testing should happen so often that it's not affordable for me as I have 12 other pets. We are doing liquid, compounded trilostane for two weeks and testing. Then in three months. When we get the three month levels back I will re-evaluate and decide if we should continue or let him live out his life.
 
I wonder if there's a cats with cushings group or something that you can join for more information regarding testing and where to get the meds.
 
Dyana said:
I wonder if there's a cats with cushings group or something that you can join for more information regarding testing and where to get the meds.
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So far, my searches only turn up FDMB for any kind of Cushing's forum. Looks like I may be flying this one solo.
 
Caroline17 said:
I researched like a fiend last night. I am not ready to give up because Vonn is still happy, engaged, and his normal jerk face/goofy self. I'm glad I did.

My vet is working with me and we've come up with a testing protocol that is more affordable. ACHT tests run ~300 per test. The recommended testing should happen so often that it's not affordable for me as I have 12 other pets. We are doing liquid, compounded trilostane for two weeks and testing. Then in three months. When we get the three month levels back I will re-evaluate and decide if we should continue or let him live out his life.
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Looks like you have a good vet and a good plan. Paws crossed for you and Vonn.
 
Unfortunately I was never able to find any support groups for Cushing's kitties. There is a Cushing's group on FB for dogs which I had belonged to just to read through progress reports, but since there is so little information on using Trilostane (vetoryl) in kitties it was not a group I was ever able to ask questions.

This is the information brochure for Vetoryl, which is another name for Trilostane. It is geared towards use with dogs, since that is the target audience for this medication, but it does give some information on monitoring once it has been started.

http://www.dechra-us.com/Admin/Publ...es/SupportMaterialDownloads/us/US-046-TEC.pdf

There are a few links to more information at this site:

http://www.dechra-us.com/therapy-ar...nine-hyperadrenocorticism/monitoring-cushings
 
Tuxedo Mom said:
Unfortunately I was never able to find any support groups for Cushing's kitties. There is a Cushing's group on FB for dogs which I had belonged to just to read through progress reports, but since there is so little information on using Trilostane (vetoryl) in kitties it was not a group I was ever able to ask questions.

This is the information brochure for Vetoryl, which is another name for Trilostane. It is geared towards use with dogs, since that is the target audience for this medication, but it does give some information on monitoring once it has been started.

http://www.dechra-us.com/Admin/Public/DWSDownload.aspx?File=/Files/Files/SupportMaterialDownloads/us/US-046-TEC.pdf

There are a few links to more information at this site:

http://www.dechra-us.com/therapy-ar...nine-hyperadrenocorticism/monitoring-cushings
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Thank you again for the info. The branded trilostane was going to cost $90 a month, which with testing and the amount we already spend on Vonn was extremely cost prohibitive. I wasn't ready to give up and not treat him so I did a ton of research and we ended up going with compounded liquid, which will run me $25 a month. I have a feeling it will work the same as the branded medication so I am definitely going to read over the information.
 
Hopefully the compounded liquid will be effective. Since kitties will use a smaller dose than dogs it makes sense to go with the compounded. The biggest expense then will be the ACTH testings which is very important, especially in the beginning so as to prevent Turner going into Addison's syndrome. Also close monitoring of glucose levels is needed once treatment is started to prevent overly low numbers or hypos.

Wishing you all the best with Turner's treatment plan. Cushing's is indeed a terrible disease to deal with. :bighug::bighug::bighug:
 
Tuxedo Mom said:
Hopefully the compounded liquid will be effective. Since kitties will use a smaller dose than dogs it makes sense to go with the compounded. The biggest expense then will be the ACTH testings which is very important, especially in the beginning so as to prevent Turner going into Addison's syndrome. Also close monitoring of glucose levels is needed once treatment is started to prevent overly low numbers or hypos.

Wishing you all the best with Turner's treatment plan. Cushing's is indeed a terrible disease to deal with. :bighug::bighug::bighug:
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Vonn lost his fight Thursday. He was vomiting profusely and turning down food. His blood work showed advances renal disease. I miss his little stripey self so much. Thank you so much for all the info you shared with me to help him.
 
Caroline17 said:
Vonn lost his fight Thursday. He was vomiting profusely and turning down food. His blood work showed advances renal disease. I miss his little stripey self so much. Thank you so much for all the info you shared with me to help him.
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OMG I am SO SO sorry!!! Cushing's takes such a toll on their poor little bodies. Take comfort in the fact that Von is no longer in pain. Now my Tuxie and your Von can run free together over the bridge, whole and happy once more.

Hold close all the special memories and let them fill that big hole in your heart. :bighug: :bighug: :bighug:

b7132030ab3a1740b0a2ae23ec8984f5--pet-loss-quotes-dog-quotes.jpg
 
I'm so sorry for your loss, ((((Caroline)))))
Know that Vonn knows how much you love him and will be waiting for your at The Bridge.
If you need to talk, or vent, or just let is out, we are here for you. We understand.
 
{{{Carolin}}} I am so sorry it was Vonn's time to earn his angel wings.:bighug: You did everything for him, it shows how much he was loved and I'm sure he knew it.
 
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